Exploring Knowledge Translation Concepts in U.S. Occupational Therapy Research: A Content Analysis

Identifying and Defining Categories of Knowledge Translation

Each author read all of the articles in detail and as a group identified two exemplar articles. These were chosen because they used a KT framework to underpin the methodology and had distinct characteristics thought to maximize the variation of our initial inductive coding. The positionality of the authors is relevant because we all have extensive training through graduate school coursework in translational health sciences (Creswell & Poth, 2018) and were or are currently enrolled in the PhD in Translational Health Sciences program at The George Washington University. To acknowledge our training and support trustworthiness, each author regularly wrote analytic memos to document self-reflections on the emerging results. Memo writing can be analytical and abstract; it allows for the creation of new concepts, formulates comparisons, and clarifies coding (Creswell & Poth, 2018). Our memos included reviewer perspectives on how each article related to advancing the field of occupational therapy by using KT principles. All memos and concepts were discussed among us. We inductively generated categories for the use of KT T/M/F.

Using categories derived from the inductive analysis, two coauthors (Jennifer A. Weaver and Halley Read) evaluated each study for codes that aligned with each category using NVivo Plus (Version 11). After coding each study for one category, these coauthors met to discuss and further define each category. Using a process of constant comparison and inductive analysis, we merged some categories and generated one new category (Creswell & Poth, 2018). During this study phase, each author engaged in discussions related to confirmability and trustworthiness.

Mapping Inductive Categories to the Knowledge-to-Action Framework

Once the studies were coded, we mapped the findings to each concept in the KTA framework’s knowledge creation and action cycles. The purpose of mapping our findings was to identify the extent to which occupational therapy research addresses each KTA framework concept.

Identifying and Defining Categories of Knowledge Translation

The initial coding process warrants further explication, given that it relates to our results. From the initial open coding and memo writing process, we generated six categories to describe the use of KT in the occupational therapy literature. After the six initial categories were created, Jennifer A. Weaver and Halley Read reread and coded all of the articles. The initial category, “includes outcomes that are formative or help to identify mechanisms of action,” was merged with “promoting applications to bridge translational chasms” because they both exemplify stages of the KTA framework (Graham et al., 2006) that support the bridging of research–practice gaps. All of us reviewed and reached a consensus on the final six categories: (1) defining KT, (2) providing information about KTA, (3) naming barriers to and facilitators of KT, (4) using a complexity lens, (5) promoting applications to bridge translational chasms, and (6) engaging stakeholders. “Engaging stakeholders’ was a new category that was generated during data analysis. The definition of and exemplary data for each category are given in Table 2.

Seven articles threaded all six categories throughout the text (Bazyk et al., 2015; Clark et al., 2013; Gitlin et al., 2010, 2017; Moore et al., 2018; Stark et al., 2018; Pyatak et al., 2019). All articles included content related to “defining KT,” “providing information about KTA,” and “naming barriers to and facilitators of KT.” Ten articles discussed “using a complexity lens” (Bazyk et al., 2015; Clark et al., 2013; Gitlin et al., 2010, 2017; Grajo & Candler, 2017; Groth, 2011; Moore et al., 2018; Myers, 2019; Pyatak et al., 2019; Stark et al., 2018). Nine articles “promoted applications to bridge translational chasms” (Bazyk et al., 2015; Clark et al., 2013; Gitlin et al., 2010, 2017; Groth, 2011; Grajo & Candler, 2017; Moore et al., 2018; Pyatak et al., 2019; Stark et al., 2018). Eight articles discussed “engaging stakeholders” (Gitlin et al., 2010, 2017; Bazyk et al., 2015; Clark et al., 2013; Moore et al., 2018; Myers, 2019; Pyatak et al., 2019; Stark et al., 2018).

Although defining KT is crucial, our results showed that providing explicit information about the KTA process is also important. More than simply explaining the need for KT, the power of providing information came when the target audience was identified, the knowledge being moved was evident, and the way the knowledge was translated was clear. Stark et al. (2018) demonstrated how the use of process evaluation methods to assess KT outcomes was not only summative but also formative. Often, researchers who provided “information about the process of KTA” promoted future applications of this knowledge from a truly translational research perspective. For example, one study shared lessons learned so that others could rationalize which KT strategies to consider (Gitlin et al., 2010). Highlighting the importance of shared understanding, Gitlin et al. (2010) identified knowledge of practice site characteristics as essential and that, to best facilitate KT, fidelity monitoring practices need to be embedded in policy, procedure, and staff practices.

All articles discussed barriers to and facilitators of KT, with considerations of multiple levels (individual, team, organizational, etc.) of the context. Articles that used a complexity lens often discussed the nonlinear perspective of stakeholders while presenting the dynamic, multidimensional nature of the problem. Pyatak et al. (2019) highlighted this complexity perspective in their description of how a recurring problem with physical treatment space changed over time and throughout the implementation process. Although stakeholder engagement adds complexity to the KT process, our results indicate that engaging stakeholders is commonly present in occupational therapy research.

Mapping Inductive Categories to the Knowledge-to-Action Framework

Each of the six categories included multiple data sources. We reviewed the data and categories and mapped them to concepts of the KTA framework (Table 3). Mapping data back to the KTA concepts allowed us to see whether categories generated from this analysis reflected concepts of the KTA framework.

We found that each of the KTA framework concepts was represented by one or more codes generated from analysis of the included studies. The knowledge creation cycle was reflected in the creation of an intervention or program, and the knowledge action cycle underpinned the process of implementing the intervention or program in clinical practice, described implications for policy, or both. Of note is that one of our categories, “engaging stakeholders,” did not explicitly map to a concept in the KTA framework. Engaging stakeholders was a category exemplified by stakeholders being engaged before and during the implementation of occupational therapy in a health system (Pyatak et al., 2019); throughout the research process using a community-of-practice approach for integrated KT (Bazyk et al., 2015); and for the dissemination of information (Clark et al., 2013). Stakeholders included researchers, health care administrators, and a variety of health care practitioners inclusive of occupational therapy.

As listed in Table 3, multiple sources of data mapped to each of the first five concepts of the knowledge action cycle. Studies were consistent in identifying a problem and then reviewing existing knowledge to select an intervention or program. However, we found that three concepts from the knowledge action cycle that represent evaluation and monitoring (specifically, “monitor knowledge use,” “evaluate outcomes,” and “sustain knowledge use”) were limited to studies that used an evaluation framework (e.g., the Reach, Effectiveness, Adoption, Implementation, Maintenance framework, Proctor’s implementation framework) or a process model (e.g., KTA). This suggests a gap between research and practice in regard to the potential to better understand the effect of KT strategies on translation.